National Data Research Articles

Inequalities in Ambulatory Care Sensitive Conditions: An International Comparison of High-Income Countries

ObjectiveTo examine the differences in inequalities in Ambulatory Care Sensitive Conditions (ACSC) hospitalizations relative to socioeconomic status across nine countries, namely Australia, Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). ApproachThe International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) research collaborative developed national data sets with hospitalization and sociodemographic data aggregated to small-area levels and pooled across countries using a common data model. Inequalities were assessed using both the slope index of inequality and the relative index of inequality. ResultsThis study developed a common definition and set of codes for ACSC hospitalizations that proved to be comparable across countries and regions. Consistent socioeconomic gradients were observed in all countries with higher ACSC hospitalization rates for individuals in most disadvantaged areas. The greatest difference in hospitalizations between the highest and lowest income quintiles were observed in New Zealand (1603 per 100,000), Finland (1802 per 100,000) and England (1955 per 100,000). ConclusionsThe high-income countries included in this study displayed many commonalities in inequalities in ACSC hospitalizations. As a proxy measure of primary care access and quality, the observed inequalities may implicate disparities in health care quality and access for the lowest socioeconomic status groups. ImplicationsBarriers to health care access in low socioeconomic groups remain a complex and multifaceted issue. Future research should investigate the underlying contributing factors to the observed ACSC hospitalization equity gradients, including primary care delivery model, remuneration approach, and population structure.

Integrating Precision Training for Building a Sustainable National Data Infrastructure in Wales: A Datacise Open Learning (DOL) Based Case Study

ObjectiveConstruct an innovative open-learning solution that provides comprehensive training specific to Trusted Research Environments (TRE) and the broader research community of administrative data users, irrespective of their proficiency levels. DOL offers training opportunities tailored to meet each user's unique learning needs, enabling them to utilise complex, linked administrative datasets confidently and effectively for meaningful research outcomes, thereby building capacity for sustainable national data infrastructure. ApproachDOL’s innovative open-learning solution offers two learning formats: adaptive and experiential. Adaptive learning provides registered users with bitesize self-paced training based on Administrative Data Research UK's priorities. Experiential learning involves online workgroups with real-world context and practical application. They meet twice a year and are designed around specific topics with frequent guest speakers who are experts in their fields. ConclusionDOL’s innovative open-learning solution empowers TREs, such as SAIL Databank, to provide well-rounded learning that fosters community support, knowledge-sharing, and networking opportunities for its users, while gathering valuable user feedback. Users can personalise learning and test their knowledge in a flexible training environment, allowing them to take charge of their learning journey. ImplicationIn response to the increasing demand for training services from novice to advanced users, SAIL Databank adopted DOL's dual learning approach by (1) developing training courses that cover access, process, methodology, integration, and analytical tools for SAIL TRE users, (2) engaging users in a series of workgroups focused on themed datasets including Justice, Environmental, Maternal, Education, and Core Health.

Surveillance of violence through health service interactions in Wales: A longitudinal national data linkage study.

Objective and ApproachThe study aimed to utilise multiple population-wide linked administrative, health, and survey data sources to identify victims from violence across various sociodemographic groups using healthcare service interactions. We calculated violence rates for the population of Wales to identify groups of people that experience higher rates of violence compared to the general population. Our approach involved creating an observational population-wide e-cohort utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. General practice records, emergency department attendances, hospital admissions, and the Office of National Statistics (ONS) deaths register were linked to the Welsh Demographic Service dataset to include individuals living in Wales, UK between 2013-2022, allowing for a 10-year analysis. ResultsIn total, 3.3 million individuals were included in the study, with 80,079 individuals having interacted with health services or died due to violence over the 10-year period. On average, every 4 per 1000 of the study population had experienced violence (2013-2022) with the majority of these being captured through emergency department attendances. 55% were male, of which 71% were aged under 35. The majority of individuals lived in the more deprived areas of Wales (61%). Conclusions and ImplicationsIt is important to understand and quantify violence over time to produce insight into which sociodemographic groups of individuals are being disproportionately impacted by violence for designing disparity-reducing policy interventions. ONS Census 2021 data will be used to examine the impact of violence by protected characteristics (e.g. disability, race, sexual orientation) under the UK Equality Act 2010.

Data as infrastructure: Systematic data curation addressing fundamental data content differences across the UK

Objective and ApproachHealth Data Research UK, the UK national institute for health data science, is coordinating efforts alongside national academic partners to streamline data curation at disease, population, and data structure level to enhance data offerings and provide networked data infrastructure supporting whole-UK research. Due to clinical, coding, and system differences across the constituent countries of the UK, data is often not standardised for whole-UK analyses, creating burden on research teams and leading to long data preparation times in order to run even distributed analyses. The approach to solve this is multi-faceted, including deploying data curation and cohort creation algorithms into health data providers’ environments, and through the novel integration of federated analytics solutions (such as those piloted through recent national infrastructure programmes) improving data access and research deployment efficiency. ResultsStandardising data through clinical and structural data curation directly deployed to health data providers creates a framework for whole-UK studies to be readily achievable, and provide the data infrastructure base to integrate new technical federated analytics solutions to deploy and reproduce analytics without unnecessary large scale data migration. Conclusions and ImplicationsSystematic curation of health data within national data providing organisations provides flexibility and choice for researchers in terms of the data they will apply for to answer vital research questions affecting the UK populace. Such advances will improve the quality and efficiency of research for all corners of the UK, and create a community of practice in terms of developing data from health systems to research environments.

Linking community-acquired images to national data in the absence of interoperable systems and unique identifiers

Objective & ApproachRoutine optometry examinations, which may include retinal images, have been free to everyone in Scotland since 2006. Images and patient data are stored locally on non-interoperable systems, usually without unique identifiers. The Scottish Collaborative Optometry-Ophthalmology Network for e-research (SCONe) aimed to create a secure, longitudinal repository collating community-acquired images linked to national, routinely-collected healthcare data. We developed bulk export processes to retrieve images and patient data from current and archived systems and a series of deterministic and probabilistic algorithms to match images to patients. ResultsWe successfully exported images and patient data from several commonly used systems. Exact matching of available data between image and clinical systems within practices linked 78% of images (IQR 71.2-84.1). Our algorithms increased match rate to 90% (IQR 83.5-98.6) of images, efficiently reducing risk of systemic bias in the cohort. Match method is included in the repository metadata to facilitate quality assurance checks after national linkage and pseudonymisation. To date over 600k images have been processed and delivered to the National Safe Haven for linkage to healthcare data. Conclusions & ImplicationsBreakthrough research into early detection and pre-symptomatic disease can be facilitated by harnessing community-acquired retinal images which capture normal ageing and disease progression. Rather than await interoperability and widespread use of unique identifiers, this has been achieved through innovative solutions to real-world issues around time-pressured clinical data entry and non-standardised data storage. The SCONe repository continues to grow. It is currently supporting ocular disease prediction research and offers the potential for much more.

Awareness and use of nicotine pouches in a nationwide sample of adults in Poland.

Nicotine pouches are a new type of nicotine-containing product that have been marketed in many countries worldwide, generating growing acceptance among consumers. The aim of this study was to assess factors associated with public awareness and use of nicotine pouches among adults in Poland. A cross-sectional survey was conducted with a nationally representative sample of 1080 adults in Poland (February 2024). Awareness of nicotine pouches, history of use, current (past 30-day) use of nicotine pouches, as well as perception of harm was assessed using a purpose-designed questionnaire. Awareness of nicotine pouches was reported by 24% of the sample, while 9.2% reported ever having used a nicotine pouch product, and 4.3% using a nicotine pouch in the past 30 days. Among all respondents, 60.7% perceived nicotine pouches as harmful as combustible cigarettes, 28.2% perceived nicotine pouches as less harmful, and 11% as more harmful than combustible cigarettes. In multivariable logistic regression model, women (adjusted odds ratio, AOR=1.40; 95% CI: 1.03-1.91; p<0.05), individuals aged <60 years (p<0.05), current tobacco smokers (AOR=2.59; 95% CI: 1.75-3.82; p<0.001), former tobacco smokers (AOR=1.53; 95% CI: 1.01-2.32; p<0.05) and ever users of e-cigarette or heated tobacco (AOR=2.90; 95% CI: 2.07-4.05; p<0.001) were more likely to declare that had ever heard of nicotine pouches. Moreover, individuals aged <60 years (p<0.05), occupationally active individuals (AOR=1.82; 95% CI: 1.01-3.31; p<0.05), current tobacco smokers (AOR=2.71; 95% CI: 1.48-4.97; p<0.01), and ever users of e-cigarette or heated tobacco (AOR=5.29; 95% CI: 2.96-9.44; p<0.001) were more likely to declare ever use of nicotine pouches. This study provides the first national data on public awareness and use (ever and current) of nicotine pouches in Poland. Young adults, current smokers, and ever e-cigarette and heated tobacco users are at higher risk of ever use of nicotine pouches, so policy interventions are needed to protect young people from nicotine pouch marketing and nicotine initiation.

SP6.8 - Predicting Determinants of Successful Transplantation Using Supra-Marginal (DRI-Donor Risk Index &amp;gt;1.5) Deceased Donor Kidneys

Abstract Objective To develop machine-learning-models with national registry data to predict factors associated with favourable outcomes using supra-marginal ( DRI -Donor Risk Index &amp;gt;1,5) deceased donor kidneys Design A retrospective cohort study using UK Transplant Registry data from 2000-2019 Setting National registry administered by NHS Blood and Transplant in the United Kingdom. Participants Adult recipients (n = 6254) of first kidney-alone transplants from very supra-marginal deceased-donors (DRI≥1.5) Main Outcome Measures Death-censored graft failure and patient mortality Predictors Comprehensive recipient, donor, and transplant characteristics. Statistical Analysis Bayesian neural networks, gradient boosting machines, random forest, and SMOTE-balanced bagging classifiers tuned using Bayesian optimisation Cox regression, competing risk analysis, and calibration plots Results Overall 5-year graft survival was 81%. The random-forest-model had excellent predictive performance for graft failure (AUC 0.88, 95% CI 0.87-0.89; RMSE 0.29). recipient age &amp;gt; 75-years (SHR 1.02, 95% CI 1.01-1.03), recipient-BMI &amp;gt;30 (SHR 1.04, 95% CI 1.02-1.07), HLA mismatches &amp;gt;4 (SHR 1.09, 95% CI 1.01-1.17), donor-creatinine &amp;gt;120mmol/L (SHR 1.002, 95% CI 1.001-1.003), and rejection- within 3-months (SHR 1.56, 95% CI 1.32-1.85) were key determinants of poor survival. Prolonged cold-ischemia-time &amp;gt;14hrs (SHR 1.01, 95% CI 1.007-1.015) was detrimental Conclusions Supra-marginal deceased-donor-kidneys can achieve excellent 5-year outcomes with careful recipient selection. Machine-learning accurately predicted factors associated with success. Adjusted predictors of graft failureVariableSHR95% CIp-valueRecipient-age &amp;gt; 75 years1.021.01-1.03&amp;lt;0.001Recipient-BMI &amp;gt;301.041.02-1.070.002HLA-mismatches &amp;gt;41.091.01-1.170.03Creatinine at offer &amp;gt;120 mmol/L/ 1.4 mg/dl1.0021.001-1.003&amp;lt;0.001Rejection at 3 month1.561.32-1.85&amp;lt;0.001Cold-ischemia-time &amp;gt;14 hrs1.011.007-1.015&amp;lt;0.001SHR: subdistribution hazard ratio;

Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study.

Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. We examined the reach of VHA's Connected Device Program using national secondary data from VHA's electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.

Drowning Among Children 1–4 Years of Age in California, 2017–2021

Background and Objectives: Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010–2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1–4 years of age from 2017–2021. Methods: We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website. Results: Over the five-year study period, 4,166 drowning incidents were identified: 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (P = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. Conclusion: Drowning remains the leading cause of unintentional, injury-related death among California children 1–4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children.

Increasing trends of antibiotic resistance in Uganda: analysis of the national antimicrobial resistance surveillance data, 2018–2021

BackgroundContinuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda.MethodsWe analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018–2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period.ResultsOut of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63–84% for sulfonamides, fluoroquinolones macrolides (46–76%), phenicols (48–71%), penicillins (42–97%), β-lactamase inhibitors (20–92%), aminoglycosides (17–53%), cephalosporins (8.3–90%), carbapenems (5.3–26%), and glycopeptides (0–20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29–78% p < 0.001), ciprofloxacin (17–43%, p = 0.004), ceftriaxone (8–72%, p = 0.003), imipenem (6–26%, p = 0.004), and meropenem (7–18%, p = 0.03).ConclusionThe study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."

Assessing Larix principis-rupprechtii productivity and its determinants based on national forest inventory data in Hebei Province, China

Tree productivity is not only determined by stand structure, but also influenced by soil chemical properties, climate and topography. However, the relative importance of each indicator on larch (Larix principis-rupprechtii) productivity were uncertain. In this study, 76 pure larch forest plots were selected based on national forest inventory (NFI) data in Hebei Province, China. Structural equation model (SEM) was used to analyze the direct and indirect effects of stand structure, soil chemical properties, climate and topography on larch productivity, and to quantify the relative importance of each indicator in determining productivity. The results showed that stem volume growth (SVG) of larch was influenced by a combination of stand density, diameter at breast height (DBH), mean winter snow (PAS), annual temperature range (TD), slope, and alkali-hydrolysis nitrogen (AN). SVG tended to increase with decreasing stand density and AN content and increasing DBH. Stand density, DBH and AN were more important than PAS, TD, and slope in explaining SVG variation. The results can provide a scientific basis for adaptive management of larch forests.

Patient satisfaction and associated factors with inpatient health services at public hospitals in Ethiopia: a systematic review and meta-analysis

BackgroundThe way the healthcare delivery system is reflected by patient satisfaction. Establishing a health system with better results depends on it. It has been assumed that higher patient satisfaction levels correlate with quality healthcare outcomes. There is little national data to support patient satisfaction with inpatient health services in Ethiopia. In order to estimate the pooled proportion of patient satisfaction and determine the associated factors with inpatient health services at public hospitals, a systematic review and meta-analysis were conducted.MethodsThe Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed in the extraction of the data. To get the included studies, the following electronic databases were searched: Pub-Med, Google Scholar, Med-Line, Web of Science, Scopus and Repositories. Software called STATA version 17 was used to analyze statistical data using the random effects model. Forest plots were used to display the pooled results.ResultsOf the 1583 records resulted in electronic databases searching, 11 studies with 3,958 participants were included in this systematic review and meta-analysis. The estimated pooled proportion of patient satisfaction with inpatient health services was found to be 57.4% (95% CI: 50.88–64.59, I2 = 95.25%). Assuring privacy for patients (OR = 7.44, 95% CI: 3.63–15.25, I2 = 0.0%), availability of direction signs (2.96, 95% CI: 1.91–4.57, I2 = 0.0%), providing adequate information (OR = 3.27, 95% CI: 1.63–6,58, I2 = 65.60%), history of previous admission (OR = 0.29, 0.18–0.46, I2 = 86.36%) and providing on time treatment (OR = 1.63, 95% CI: 1.21–2.20, I2 = 86.36%) were statistically significant factors associated with patient satisfaction with inpatient health services.ConclusionThe estimated pooled level of patient satisfaction with inpatient health services is low in Ethiopia. A higher level of patient satisfaction with inpatient health treatments was predicted by factors such as privacy assurance, fast services, availability of direction signs, provision of services with adequate information transfer, and no history of previous admission. To improve patient satisfaction, the Ministry of Health and hospital administration must place a strong emphasis on ensuring the provision of high-quality, standard-based inpatient healthcare.

A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations

Potentially Preventable Hospitalisations (PPH) is a widely used indicator of the effectiveness of non-hospital care. Specified using the International Classification of Diseases (ICD) coding, PPH comprises a suite of health conditions that could have potentially been prevented with appropriate care. The most recent edition of the National Guide to a Preventative Health Assessment for First Nations People documents the health conditions of interest to providers of primary care, many of which are not represented in PPH. Given the National Guide has been developed specifically with First Nations in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences. Age-standardised hospitalisation rates from 2016–17 to 2019–20 using both classifications were examined to assess the usefulness and relevance of summative measures of hospitalisations for informing primary care. Rates of FNPHC for principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses. There was a strong correlation with PPH when rates were compared across all observations: jurisdictions with higher rates of PPH tended to have higher rates of hospitalisations according to the custom specification. Findings support its application as a summary measure for First Nations primary care providers. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.

FP4.16 - Impact of Clinician Factors and Judgement Biases on Delayed Referrals and Diagnosis of Colorectal Cancer (CRC)

Abstract Aim Colorectal cancer (CRC) is the 4th most common cancer in the U.K. contributing to 10% of cancer-related fatalities. Despite clear NICE referral guidelines, there are various patient-, clinician- and system-related delays in referrals to the lower gastrointestinal (LGI) services. Our article investigated clinician-associated biases that govern the timeliness of referral to the LGI services. Method Our article is a narrative review. We searched Embase and Ovid Medline databases using a range of terms. Results yielded 36 articles relevant to our topic. Results GP referrals make up 44%-69% of suspected CRC referrals. Yet, national data highlights that emergency presentations range from 14%-30% nationwide, indicating missed opportunity in the primary care setting. Cognitive bias was commonly seen and included GP’s poor familiarity with referral criteria and failure to recognise red flags. Patient cultural and demographical biases played a significant role in decision-making often leading to misappraisal, with the patient’s age being the most common factor. Younger patients were less commonly referred onto the 2-week-wait (2ww) pathway, and faced an average delay in diagnosis of a month with 1.4 times more visits to care providers. In addition, information and communication biases were a recurring theme in the literature which discussed the effects of inadequate histories and physical examinations on missed diagnosis and delayed referrals. Conclusions Unintentional bias delays CRC referrals resulting in a substantial proportion of patients presenting as an emergency with advanced stage cancer that has poorer outcome. We need to increase awareness of these biases and find ways to negate their effects in clinical decision-making.

Cancer risk among air transportation industry workers in Korea: a national health registry-based study

BackgroundFlight attendants face various risk factors in their working environments, particularly occupational exposure to cosmic radiation. This study aimed to assess cancer risk among air transportation industry workers, including flight attendants, in Korea by constructing a cohort using national health registry-based data and analyzing cancer incidence risk.MethodsWe used the Korea National Health Insurance Service database from 2002 to 2021 to construct a cohort of 37,011 workers in the air transportation industry. Cancer incidence was defined using the tenth version of the International Classification of Diseases. We calculated the age- and sex-specific standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) by applying the cancer incidence rate of the general population between 2002 and 2019.ResultsApproximately 5% of the cohort developed cancer. Overall, the cancer incidence in the cohort was similar to or lower than that of the general population, with the SIRs for all cancers being lower. However, significantly higher SIRs were observed for nasopharyngeal cancer (SIR, 3.21; 95% CI, 1.71–5.48) and non-Hodgkin lymphoma (SIR, 1.57; 95% CI, 1.02–2.32) in male workers and breast and genital cancer (SIR, 1.51; 95% CI, 1.34–1.70) and thyroid cancer (SIR, 1.25; 95% CI, 1.05–1.47) in female workers.ConclusionsThe lower overall cancer incidence among air transportation industry workers observed in this study could indicate the “healthy worker effect”; however, the incidences of certain cancers were higher than those in the general population. Given that these workers are exposed to multiple occupational and lifestyle-related risk factors, including cosmic radiation, further studies are necessary to determine radiation-induced cancer risk while considering potential confounding factors.

Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study

ObjectiveTo provide a baseline comparative assessment of the main epidemiological features of prostate cancer in European populations as background for the proposed EU screening initiatives.DesignPopulation based study.Setting26 European countries, 19...

Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis.

The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed. This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic. Interrupted time series analysis of national medical claims data. Individuals with home medical care use occurring in Japan between April 2019 and March 2022. The declaration of a state of emergency (April 2020) by the Japanese government. The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals). Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43to2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549to1683; 1459 uses/month, 95% CI 612to2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73to209; 215 uses/month, 95% CI 114to317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals. The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

Parathyroidectomy and the Development of New Depression Among Adults With Primary Hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown. To determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management. Analyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023. Early parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management. New depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL). The study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium. In this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.

Examining the evolving landscape of liver cancer burden in the United States from 1990 to 2019

IntroductionLiver cancer (LC) is frequently preceded by cirrhosis and poses a significant public health challenge in the United States (US). Recent decades have seen notable shifts in the epidemiological patterns of LC, yet national data guiding the optimal allocation of resources and preventive efforts remain limited. This study aims to investigate the current trends, risk factors, and outcomes of LC in the US.MethodsThis study utilized the Global Burden of Disease (GBD) dataset to collect data on the annual incident cases, deaths, Disability-Adjusted Life Years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized DALY rates of primary LC and its etiologies and risk factors, between 1990 and 2019. Percentage changes in incident cases, DALYs, and deaths and the estimated annual percentage change (EAPC) in ASIR and deaths rates of LC were calculated to conduct temporal analysis. Linear regression was applied for the calculation of EAPCs. Correlations of EAPC with socio-demographic index (SDI) were separately evaluated by Pearson correlation analyses.ResultsWe observed a marked increase in the ASIR of LC, increasing from 2.22 (95% CI: 2.15–2.27) per 100,000 people in 1990 to 5.23 (95% CI: 4.28–6.29) per 100,000 people in 2019, a percentage change of 135.4%. LC due to hepatitis C followed by alcohol use were the primary factors driving this increase. The ASIR and age-standardized death rates of LC showed a significant average annual increase of 3.0% (95% CI: 2.7–3.2) and 2.6% (95% CI: 2.5–2.8), respectively. There was a significant negative correlation between the SDI and the EAPC in ASIR (ρ = -0.40, p = 0.004) and age-standardized death rates (ρ = -0.46, p < 0.001). In 2019, drug and alcohol use, followed by elevated body mass index (BMI) were the primary risk factors for age-standardized DALY rates attributable to LC.ConclusionThe increased burden of LC in the US highlights the need for interventions. This is particularly important given that LC is mostly influenced by modifiable risk factors, such as drug and alcohol use, and elevated BMI. Our findings highlight the urgent need for public health interventions targeting socio-economic, lifestyle, and modifiable risk factors to mitigate the escalating burden of LC.

A Retrospective Cohort Analysis Comparing the Costs of Ankle Fracture Fixation in Orthopaedics and Podiatry in a U.S. Medicare Limited Data Set.

Increasing overlap exists between surgeries performed by podiatrists and orthopaedic surgeons. Large-scale cost comparisons between the two are lacking despite the current climate of cost containment in health care. Using national Medicare data, we aimed to compare per-case Medicare payments between podiatrists and orthopaedic surgeons for ankle fracture fixation. This retrospective cohort study included patients in an outpatient setting undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair from the national Medicare Limited Data Set (2013-2019). Type of surgeon (podiatrist or orthopaedic surgeon) was determined using publicly available information. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost. A subset analysis was also done to directly compare costs of orthopaedic surgeons to podiatric surgeons while excluding other fees (eg, hospital facility fees and surgery-related imaging payments). Additionally, patient demographics and hospital characteristics were compared to determine if any factors associated with costs may influence group differences. Univariable tests assessed significance of group differences. Overall, 16 927 unimalleolar, 17 244 bimalleolar, and 11 717 trimalleolar fracture repairs were included; 86.7% and 13.3%, 92.4% and 7.6%, and 92.2% and 7.8% were performed by an orthopaedic surgeon or podiatrist, respectively. Median age (70-71 years) and median Charlson-Deyo Comorbidity Index (0) did not significantly differ between patients treated by either surgeon type. Median procedure-specific Medicare payments for all 3 categories of ankle fracture repairs (uni-, bi-, trimalleolar) were significantly lower for orthopaedic surgeons compared to podiatrists: $4156 vs $4300, $4205 vs $4379, and $4396 vs $4525, respectively (all P < .001). Our investigation using a national Medicare data set (2013-2019) found that the 3 types of ankle fractures (unimalleolar, bimalleolar, and trimalleolar) performed by orthopaedic surgeons in an outpatient setting were less expensive and that cost differences do not appear to be driven by patient characteristics. These results and further research into the causes of the cost differences may help improve the cost-effectiveness of ankle fracture surgery.